Corporation: Piedmont Healthcare Initiated: 11.18.2013
Distribution: Vascular Lab Southern Vein Care supersedes none
Subject: Safe Use of Gels for Ultrasound
Safe Use of Gels for Ultrasound
Purpose: To minimize the risk of infection due to use of ultrasound gels in the vascular laboratory or in Southern Vein Care.
Audience: All healthcare workers in the Southern Vein Care clinic and vascular lab.
Policy:
Use of Sterile Ultrasound Gel
· Use of sterile ultrasound gel as recommended in clinical practice
standards for all sterile body site procedures and any invasive
procedures using ultrasound-guided biopsy or ultrasound-guided
device insertion (1-5).
· Use sterile ultrasound gel for procedures with mucosal contact where
biopsy is not planned but any possible added bio burden would be
undesirable or mucosal trauma is likely (e.g., transesophageal
echocardiography [TEE] procedures, transvaginal ultrasound
procedures without biopsy and transrectal ultrasound procedures
without biopsy). (1, 6-8)
· Use sterile ultrasound gel for all procedures on Pediatric patients
including neonatal patients. (1, 9, 10)
Use of Non-Sterile Ultrasound Gel
· Use open containers of ultrasound gel only for low risk procedures
on intact skin and for low risk patients.
· For non-sterile ultrasound gel, single use containers are
recommended rather than refillable multi-dose bottles.
· If single use containers are not used, the following guidelines must
be followed for reusable bottles
- Prior to refilling reusable bottles, ensure that the large bulk
container of ultrasound gel has not passed the expiration date.
- Prior to refilling, bottles must be emptied and dried. Caked gel
must be thoroughly removed from the neck of the bottle and
inside the bottle lid.
- Bottles must then be washed in hot soapy water and thoroughly
rinsed. Only completely intact bottles may be reused.
- When in use, bottles must not be “topped off”. They must be
used until empty and then reprocessed prior to refilling.
- Bottles must be filled using a dispensing device that has been
attached to the large bulk container and not by inserting the tip
of the reusable bottle into the large bulk container to aspirate
the contents.
- When refilling the bottle, do not touch the opening of either
container with your hands or allow your hands to touch other
environmental surfaces. Maintain aseptic technique during the
refilling process.
- Bottles must be refilled as close as possible to the time of use.
- Expiration dates on bulk containers need to be carefully
monitored and containers discarded by the expiration date.
- Gel dispensed into a refillable bottle will expire in 30 days. The
date of expiration must be written on the bottle at the time it is
refilled.
- Bottles of ultrasound gel must also have a discard date written
on them when they are first opened. The discard date is 30
days from when the bottle was opened.
- Unused gel in a bottle or a refillable bottle must be discarded at
the end of 30 days or by the manufacturer’s expiration date,
whichever comes first.
- Dispensing nozzles must not come into direct contact with
patients, staff, instrumentation or the environment. Dispense
the ultrasound gel from the bottle into a cup or onto a
disposable cloth; if this is not possible, wipe the dispensing
nozzle with a clean alcohol swab between patients. Wipe the
outside of the ultrasound gel bottle with a Cavicide wipe
between patients.
- For patients on isolation precautions, use a single dose packet
of ultrasound gel to prevent contamination of a bottle of gel.
- Warming ultrasound gels
o Warm ultrasound gel only when needed
o Bottles should be removed from the warmer as soon as
possible and dried immediately. Do not store the
ultrasound gel bottles in the warmer throughout the day.
o Gel warmers must be cleaned weekly according to
manufacturer’s instructions for use with a low-level
hospital grade disinfectant. If the warmer becomes
soiled, it should be cleaned immediately with low-level
hospital grade disinfectant.
- Storage of ultrasound gel
o Bulk bottles and prefilled bottles of ultrasound gel should
be stored in an area that is dry and protected from
potential sources of contamination such as dust,
moisture, insects and rodents.
o If evidence of potential contamination is present, or if the
package integrity has been breached, the ultrasound gel
must be discarded immediately (11-14).
References:
1. Centers for Disease Control and Prevention. Safety Communication: Bacteria
Found in Other –Sonic Generic Ultrasound Transmission Gel Poses Risk of
Infection. http://emergency.cdc.gov/coca/reminders/2012/2012apr20.asp.
Accessed on 7/28/13.
2. Keizur JJ, Lavin B, Leidich RB. Iatrogenic urinary tract infection with
Pseudomonas cepacia after transrectal ultrasound guided needle biopsy of the
prostate. J Urol 1993;149: 523-526.
3. Organ M, Grantmyre J, Hutchinson J. Burkholderia cepacia infection of the
prostate caused by inoculation of contaminated ultrasound gel during transrectal
biopsy of the prostate. Can Urol Assoc J 2010; 4:E58-E60.
4. Olshtain-Pops K, Block C, Temper V, Hidalgo-Grass C, Gross I, Moses AE,
Gofrit ON, Benenson S. An outbreak of Achromobacter xylosoxidans associated
with ultrasound gel used during transrectal ultrasound guided prostate biopsy. J
Urol 2011;185:144-147.
5. Hutchinson J, Runge W, Mulvey M, Norris G, Yetman M, Valkova N, Villemur R,
Lepine F. Burkholderia cepacia infections associated with intrinsically
contaminated ultrasound gel: the role of microbial degradation of parabens. Infect
Control Hosp Epidemiol 2004;25:291-296.
6. Kanemitsu K, Endo S, Oda K, Saito, K Kunishima H, Hatta M, Inden K, Kaku M.
An increased incidence of Enterobacter cloacae in a cardiovascular ward. J Hosp
Infect 2007;66:130-134.
7. Chittick P, Russo V, Sims M, Robinson-Dunn B, Oleszkowicz S, Sawarynski K,
Powell K, Makin J, Darnell E, Boura JA, Boyanton B, Band J. An outbreak of
Pseudomonas aeruginosa respiratory tract infections associated with intrinsically
contaminated ultrasound transmission gel. Infect Control Hosp Epidemiol
2013;34:850-853.
8. Gaillot O, Maruéjouls C, Abachin É, Lecuru F, Arlet G, Simonet M, Berche P.
Nosocomial outbreak of Klebsiella pneumoniae producing SHV-5 extendedspectrum
B-lactamase, originating from contaminated ultrasonography coupling
gel. J Clin Microbiol 1998;36:1357-1360.
9. Weist K, Wendt C, Petersen LR, Versmold H, Rüden H. An outbreak of
pyodermas among neonates caused by ultrasound gel contaminated with
methicillin-susceptible Staphylococcus aureus. Infect Control Hosp Epidemiol
2000;21:761-764.
10. Jacobson M, Wray R, Kovach D, Henry D, Speert D, Matlow A. Sustained
endemicity of Bulkholderia cepacia complex in a pediatric institution, associated
with contaminated ultrasound gel. Infect Control Hosp Epidemiol 2006;27:362-
366.
11. Medical gels and the risk of serious infection. Health Canada. Notice to hospitals:
important safety information on ultrasound and medical gels. 2004 October 20.
Available: www.hc-sc.gc.ca/hpfbdgpsa/
tdp/ultrasoundgel_e.html(accessed2004Oct27).
12. Oleszkowicz SC, Chittick P, Russo V, Keller P, Sims M, Band J. Infections
associated with use of ultrasound transmission gel: proposed guidelines to
minimize risk. Infect Control Hosp Epidemiol 2012;33:1235-1237.
13. CHICA-Canada Position Statement. Medical gels. Original: November 2003. Last
revision: March 2005.
14. Creighton Medical Association. Policy 1-20. Ultrasound gel use, handling and
storage. 5/20/12.